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Vascular malformations refer to abnormal vessels that form a
direct connection between arteries and veins in the absence of blood
flowing through the normal structures. Extracranial malformations
occur in the tissues of the face and neck, whereas paraspinal
malformations involve the tissues surrounding the spine.
These types of vascular malformations can produce problems by
enlarging and putting pressure on the surrounding structures.
Symptoms that may result include deformity of the tongue, lip,
eyelid, or other facial features. Difficulty with vision or
swallowing may also result. Pain may occur due to pressure applied
to the nerves in the area.
Vascular malformations can lead to congestive heart failurea
condition that results when the heart is unable to pump enough blood
to meet the body’s demands. This can occur if the blood flows
through the abnormal vessels at a high volume and speed.
Vascular lesions are often congenital – present at birth—and can
change or, in many cases, disappear as the child grows. Some types
of birth marks seen in infants are actually the result of vascular
malformations.
There are a number of instances, however, when vascular lesions
may require treatment. When they do not disappear, when they
increase in size with age, when they appear later in life, or when
they result in symptoms, treatment may be recommended.
Depending on the type of malformation, various treatment
modalities may be recommended. Surgery or laser therapy are some
options. In other cases, embolization may be required. Embolization
is similar to an angiogram in that a tube or catheter is inserted
into the leg and guided to the blood vessels supplying the
malformation through the use of x-ray technology. Material is then
injected to block of the blood supply.
Embolization from start to finish
Prior to undergoing embolization, patients are expected to sign a
consent form and will have the opportunity to have questions
answered. The anesthesiologist will administer medications and
fluids through the use of an intravenous line (IV) into a vein in
the hand or arm. He or she will also administer general anesthesia
so that the patient will be completely asleep for the procedure.
Blood pressure will be monitored through an A-Line, a thin flexible
tube or catheter placed in an artery in your wrist. An
electrocardiogram (EKG) will monitor heart rate and rhythm as well
as oxygen levels. A specific type of catheter known as a Foley will
be placed in the bladder to allow urine to drain.
Once the procedure is complete, the patient will be transferred
from the operating room to either the Surgical Intensive Care Unit (SICU)
or the Post-Anesthesia Care Unit (PACU). Here, a heart monitor will
closely monitor vital signs. This machine is very sensitive and
often sounds inadvertently; this is not cause for alarm. The nursing
staff will assist in changing positions, but bed rest is required.
Eventually, the patient can look forward to a normal diet and
transfer to a room on a surgical floor. The Foley catheter will also
be removed prior to leaving the bed for the first time.
Patients are expected to keep the leg that underwent surgery
straight for several hours and a tube may remain in place at the
puncture sight for several days. Once it is removed, the physician
will apply pressure for about 20 minutes to prevent bleeding, and a
device may be used to seal the puncture.
A similar procedure may also be conducted in which a needle is
inserted through the skin into the lesion, and material is injected
to block off the malformation.
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